Apparently, Bernard Avishai prefers to cast aspersions on critics of President Obama’s healthcare program, rather than actually addressing legitimate dissent. The president’s plan has two major components: expanding Medicaid coverage for the working poor, and a system of exchanges for other uninsured folks to purchase insurance from private companies. It is estimated that Medicaid coverage will expand by 12 million to 15 million beneficiaries. In my opinion, this in itself is such a huge gain for working-class people that Obama’s program merits support. However, the other portion is problematic because insurance does not equal healthcare.

If we look at the Massachusetts model, we can see the implications for Obama’s plan. As Marx might say, De te fabula narratur. Since Romneycare went into effect, there has been a marked increase in the sale of high-deductible plans. Not coincidentally, in surveys as many as 20 percent of Massachusetts residents say they forgo healthcare due to the expense. Furthermore, Romneycare has seen no significant decrease in bankruptcies due to medical expenses. Unfortunately, we can expect the same type of results once Obama’s plan goes into effect at the national level.

Avishai references Arnold Relman, but does not mention that Relman has written extensively on health reform, and predicts that Obama’s plan will fail in the medium term for some of the above reasons. One additional note: Obama’s former budget director (now with Citigroup), Peter Orszag, has predicted that employer-paid health insurance will go the way of the private pension, and be replaced by employers’ handing their workers lump-sum payment to purchase insurance on the private market. The health insurance exchanges may have the unintended consequence of fostering this shifting of risk from corporate America to working America. And contrary to Avishai’s argument, pointing out these inconvenient facts does not make one a tool of reaction.

Bernard Avishai’s explanation of the nature of Congress since Obama’s election is about the best I’ve seen, but here’s how I sum up all the legislation passed and signed by Obama:

Every law Obama has signed required the vote of at least two members of Congress who opposed Obama’s election to be president, and once Obama took office, the Republican caucus treated Obama as an illegitimately elected president by requiring members to oppose everything Obama proposed.

All legislation passed in the first six months of 2009 required the votes of three to five senators who opposed Obama’s election. Of those in the Republican caucus, they were threatened with Republican caucus sanctions. Even in the second half of 2009, when all elected Democrats or their replacements were finally seated, all laws passed required the votes of two senators who opposed Obama’s election to president: Sen Lieberman and Sen Specter.

Never has a Republican president been faced with a Democratic Congressional caucus that as a matter of policy treated the president as illegitimately elected. Even President G.W. Bush, who got less votes than his opponent, got more Democratic votes for his legislation in his first two years than Obama’s legislation did Republican votes.